title: Prevention of recurrent preterm birth: role of the neonatal follow-up program.
abstract: Preterm birth (PTB) is a public health crisis in need of effective preventative strategies. Multi-disciplinary Neonatal Follow-up Programs (NFPs) provide health services to preterm infants at high risk for developmental problems after discharge from US newborn intensive care units. We aimed to determine whether NFPs are a potentially effective venue for specialized maternal counseling and intervention aimed at reducing the high rate of recurrent PTB in this population. This prospective case series enrolled women with preterm children evaluated in the Utah Department of Health NFP, 2010-2012. Women were interviewed, received Maternal Fetal Medicine (MFM) counseling services, and maternal and neonatal records were abstracted. We assessed maternal demographics, medical history, and characteristics of the index pregnancy. We calculated the proportion of women with knowledge of PTB recurrence risk and available prevention strategies, and assessed current contraceptive use and reproductive plans. Ninety-six women with a history of early PTB (≤26 weeks and/or birth weight < 1,250 g) were evaluated. Nearly 1 in 5 women (19.8 %) evaluated reported sexual activity, desire to avoid pregnancy, and no current contraceptive use, and were therefore at imminent risk of unintended pregnancy. Of women without permanent contraception, only 24.3 % were aware of their individual PTB recurrence risk. Of women with a history of spontaneous PTB, only 4 % were aware of effective pharmacologic preventative strategies. Introduction of MFM consultation as part NFP multi-disciplinary services is a novel approach with the potential to reduce recurrent PTB in an exceptionally high-risk population.
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah School of Medicine, Suite 2B200, 30 N 1900 E, Salt Lake City, UT, USA, erin.clark@hsc.utah.edu.
authors.forename: Erin A S
authors.initials: EA
authors.lastname: Clark
authors.forename: Sean
authors.initials: S
authors.lastname: Esplin
authors.forename: Leah
authors.initials: L
authors.lastname: Torres
authors.forename: David
authors.initials: D
authors.lastname: Turok
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Yoder
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
authors.forename: Sarah
authors.initials: S
authors.lastname: Winter
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D008429:Maternal Welfare; D008875:Middle Aged; D010353:Patient Education as Topic / Q000458:organization & administration*; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology / Q000517:prevention & control*; D011322:Primary Prevention / Q000458:organization & administration*; D015397:Program Evaluation; D011446:Prospective Studies; D012008:Recurrence; D013997:Time Factors; D014589:Utah; D055815:Young Adult